Perceived barriers to care, service utilization, and health in older African American adults living with HIV

Background: Older African Americans living with HIV represent a growing population in urgent need of affordable and accessible health care services. Understanding barriers to care and their links to health service utilization and clinical health outcomes is necessary. Methods: 136 HIV-positive African Americans ages 50+ completed measures of perceived barriers to care, service utilization (past 4 months), and health (HIV symptoms and physical wellbeing). Regression analyses, controlling for gender, income, age, and time since diagnosis, assessed perceived barriers in relation to service utilization and health, and indirect effects were examined via bootstrapping. Results: Participants reported problems with personal resources (e.g., finances; 77.9%), community stigma (64.0%), geography/distance (37.5%), and healthcare system limitations (e.g., shortage of psychological services; 33.8%) as barriers to care. However, most (89.0%) had recently utilized one or more services, visiting primary care physicians (86.0%), case managers (58.1%), mental health providers (53.7%), medical specialists (25.0%), and/or other care providers (24.3%). On average, participants attended 8 visits in the past 4 months with 3 different types of providers. Among those with scheduled appointments (n = 122), 27.9% failed to attend one or more. Perceived barriers were not significantly associated with number of provider visits, number of provider types seen, or appointment attendance, but were associated with more HIV symptoms and lower physical wellbeing. Service utilization did not mediate the relationship between perceived barriers and health. Conclusions: Structural barriers to care were widely acknowledged as a problem and linked to poorer health. Mechanisms explaining this relationship should be explored and addressed.